Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension

Abstract

This review summarizes several scientific contributions at the recent Satellite Symposium of the European Society of Hypertension, held in Milan, Italy. Arterial stiffening and its hemodynamic consequences can be easily and reliably measured using a range of noninvasive techniques. However, like blood pressure (BP) measurements, arterial stiffness should be measured carefully under standardized patient conditions. Carotid-femoral pulse wave velocity has been proposed as the gold standard for arterial stiffness measurement and is a well recognized predictor of adverse cardiovascular outcome. Systolic BP and pulse pressure in the ascending aorta may be lower than pressures measured in the upper limb, especially in young individuals. A number of studies suggest closer correlation of end-organ damage with central BP than with peripheral BP, and central BP may provide additional prognostic information regarding cardiovascular risk. Moreover, BP-lowering drugs can have differential effects on central aortic pressures and hemodynamics compared with brachial BP. This may explain the greater beneficial effect provided by newer antihypertensive drugs beyond peripheral BP reduction. Although many methodological problems still hinder the wide clinical application of parameters of arterial stiffness, these will likely contribute to cardiovascular assessment and management in future clinical practice. Each of the abovementioned parameters reflects a different characteristic of the atherosclerotic process, involving functional and/or morphological changes in the vessel wall. Therefore, acquiring simultaneous measurements of different parameters of vascular function and structure could theoretically enhance the power to improve risk stratification. Continuous technological effort is necessary to refine our methods of investigation in order to detect early arterial abnormalities. Arterial stiffness and its consequences represent the great challenge of the twenty-first century for affluent countries, and “de-stiffening” will be the goal of the next decades.

Effect of age and Blood Pressure on Surrogate Markers of Atherosclerosis in Patients with Type 2 Diabetes Mellitus

“…[ arterial stiffness measurement and is a well-recognised predictor of adverse cardiovascular outcome [15]. Thus, findings of the present study imply that arterial stiffness in diabetic patients is more severe than those of healthy individuals.…”

Аrterial stiffness and cardiovascular autonomic neuropathy relationship in children and adolescents with type 1 diabetes mellitus

“…Однако связь жесткости магистральных артерий с КАН установлена только во взрослой популя-ции [15]. При этом повышение ригидности аорты, оце-ниваемое по степени увеличения в ней СПВ, является независимым предиктором риска сердечно-сосудистых заболеваний в общей популяции и сердечно-сосуди-стой смертности у пациентов с АГ и почечной недоста-точностью [4,16]. Повышенная жесткость сосудистой стенки является результатом эндотелиальной дисфунк-ции -раннего признака сердечно-сосудистых заболева-ний, который раньше проявляется и чаще встречается у пациентов с СД1 по сравнению со здоровой популя-цией.…”

Aging in blood vessels. Medicinal agents FOR systemic arterial hypertension in the elderly

“…Arterial stiffening and its hemodynamic consequences can be easily and reliably measured and arterial stiffness and its consequences represent the great challenge of the twenty-first century for affluent countries (Palatini et al, 2011). Age-associated changes in the large arteries are complex and therefore, there are different parameters relating to vascular aging which can be measured.…”